Comparison of the outcomes between anterior cervical discectomy and fusion versus posterior laminectomy and fusion for the treatment of multi-level cervical spondylotic myelopathy combined with cervical kyphosis

Abstract

Objective: To compare the outcomes between anterior cervical discectomy and fusion (ACDF) and posterior laminectomy and fusion(LF) for multilevel cervical spondylotic myelopathy combined with cervical kyphosis. Methods: From January 2010 to June 2014, 54 patients with cervical spondylotic myelopathy combined with cervical kyphosis underwent surgical treatment.Among them, 29 patients were underwent ACDF, and 25 patients were underwent LF in Department of spine surgery, Tianjin Union Medical Centre. The operation time, intraoperative blood loss, fusion segments, Japanese Orthopaedic Association (JOA)score, Neck Disability Index (NDI), Visual Analog Scale (VAS), change of cervical curvature, range of motion(ROM)and complications were recorded and compared between the two groups. Results: Mean operative time was (162.7±21.3)min in the anterior approach group versus (176.3±29.8)min in the posterior group(P>0.05). Mean intraoperative blood loss was (135.6±27.8)ml in the anterior approach group and (255.2±32.3)ml in the posterior approach group(P<0.05). Mean fusion levels are (4.1±0.3)in the anterior approach group and (5.3±0.5) in the posterior approach group(P<0.05). The mean preoperative JOA score were(8.3±2.7)in the anterior approach group and( 8.9±2.1) in the posterior approach group (P>0.05). Mean postoperative JOA score were(13.6±2.5) in the anterior approach group and (14.0±1.7)in the posterior approach group at final follow-up(P>0.05). Mean improvement rate was (55.7%±16.3%)in the anterior approach group and (58.3%±15.7%) in the posterior approach group (P>0.05). Mean preoperative NDI score were(33.8±11.0)in the anterior approach group and (34.4±8.7)in the posterior approach group (P>0.05). Mean postoperative NDI score were (16.9±7.5) in the anterior approach group and (15.5±8.1) in the posterior approach group at final follow-up (P>0.05). Mean VAS score were (2.9±1.5) in the anterior approach group and (2.5±1.0) in the posterior approach group before operation(P>0.05), they are improved to (1.2±1.2) and (1.2±1.3), respectively(P>0.05). Mean Cobb angle of the operative site were (-24.3±4.4)°in the anterior approach group and (-22.7±3.7)° in the posterior approach group before operation(P>0.05). At final follow-up, the Cobb angle of the operative site were (13.7±3.2)°in the anterior approach group and (6.2±4.2)° in the posterior approach group(P<0.01). Mean preoperative ROM were (29.0±6.7)°and (30.4±5.4)° in the anterior approach group and posterior approach group, respectively(P>0.05). Mean postoperative ROM were (11.7±6.5)° and (8.2±5.9)°in the anterior approach group and the posterior approach group, respectively(P<0.05). There were 16 patients with complications in the anterior approach group and 7 patients with complications in the posterior approach group(P<0.05). Conclusion: For multilevel cervical spondylotic myelopathy combined with cervical kyphosis, ACDF can restore the lordosis better, fuse less levels but have more complications compared with LF. Patients treated with LF can get as good life quality as with ACDF and have less complications although fuse more levels compared with ACDF.